FACIAL GROWTH AND DEVELOPMENT IN UNILATERAL CLEFT-LIP AND PALATE DURING THE PERIOD OF PUBERTY - COMPARISON OF THE DEVELOPMENT AFTER PERIOSTEOPLASTY AND AFTER PRIMARY BONE-GRAFTING

X-ray cephalometry was used in studies of facial growth and developmen t carried out in 32 males with complete unilateral cleft lip and palat e. They underwent primary periosteoplasty and were examined at the age s of 10 and 15 years. The results were compared with the development o f the face in a longitudinal study of 20 males with the same type of c left who were operated with a primary bone graft. The series with peri osteoplasty showed a more marked proclination of the upper dentoalveol ar component with the restoration of a positive overjet, as compared t o a persistent anterior crossbite in the males with bone grafts. The l ower jaw showed a larger protrusion, while individuals with bone graft s were characterized at the ages of 10 and 15 years by a larger poster ior rotation of the mandible. The growth of the maxilla did not differ between series. In both series, there was a marked reduction in the g rowth of maxillary depth and of upper lip height, while the highest gr owth rate showed parameters of nasal prominence. An increasing mandibu lar protrusion and maxillary retrusion resulted in an impairment of sa gittal jaw relations and in the flattening of the face, both of which occurred in almost all patients. The rotation of the lower jaw was not correlated with either the convexity of the face, sagittal jaw relati ons, or an overjet. The independence of developmental changes of selec ted characteristics at their initial state documented the impossibilit y of predicting the development of the face on the basis of a single x -ray examination at a given stage of development. Fixed appliances pro moted a more marked proclination of upper incisors and the alveolar pr ocess than removable appliances, but they exerted no direct action on the other facial parameters studied.